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Summary Multi‐omics approach was adopted to investigate the modulation of bacterial microbiota and metabolome as well as their interactions in whole crop corn ensiling systems by inoculating homofermentative Lactobacillus plantarum or heterofermentative Lactobacillus buchneri. Inoculations of the two different inoculants resulted in substantial differences in microbial community and metabolic composition as well as their dynamics in ensiled corn. Inoculants also altered the correlations of microbiota in different manners, and various keystone species were identified in corn silages with different treatments. Many metabolites with biofunctional activities like bacteriostatic, antioxidant, central nervous system inhibitory and anti‐inflammatory were found in the present silage. A constitutive difference in microbiota dynamics was found for several pathways, which were upregulated by specific taxa in middle stage of fermentation, and widespread associations between metabolites with biofunctions and the species of lactic acid bacteria dominated in silage were observed. Multiple microbial and metabolic structures and dynamics were correlated and affected the fermentation process of the corn ensiling systems. Results of the current study improve our understanding of the complicated biological process underlying silage fermentation and provide a framework to re‐evaluate silages with biofunctions, which may contribute to target‐based regulation methods to produce functional silage for animal production.

We use a non-invasive MRI proxy of neurovascular function (pnvf) to assess the ability of the vasculature to supply baseline metabolic demand, to compare pediatric and young adult congenital heart disease (CHD) patients to normal referents and relate the proxy to neurocognitive outcomes and nitric oxide bioavailability. In a prospective single-center study, resting-state blood-oxygen-level-dependent (BOLD) and arterial spin labeling (ASL) MRI scans were successfully obtained from 24 CHD patients (age = 15.4 ± 4.06 years) and 63 normal referents (age = 14.1 ± 3.49) years. Pnvf was computed on a voxelwise basis as the negative of the ratio of functional connectivity strength (FCS) estimated from the resting-state BOLD acquisition to regional cerebral blood flow (rCBF) as estimated from the ASL acquisition. Pnvf was used to predict end-tidal CO2 (PETCO2) levels and compared to those estimated from the BOLD data. Nitric oxide availability was obtained via nasal measurements (nNO). Pnvf was compared on a voxelwise basis between CHD patients and normal referents and correlated with nitric oxide availability and neurocognitive outcomes as assessed via the NIH Toolbox. Pnvf was shown as highly predictive of PETCO2 using theoretical modeling. Pnvf was found to be significantly reduced in CHD patients in default mode network (DMN, comprising the ventromedial prefrontal cortex and posterior cingulate/precuneus), salience network (SN, comprising the insula and dorsal anterior cingulate), and central executive network (CEN, comprising posterior parietal and dorsolateral prefrontal cortex) regions with similar findings noted in single cardiac ventricle patients. Positive correlations of Pnvf in these brain regions, as well as the hippocampus, were found with neurocognitive outcomes. Similarly, positive correlations between Pnvf and nitric oxide availability were found in frontal DMN and CEN regions, with particularly strong correlations in subcortical regions (putamen). Reduced Pnvf in CHD patients was found to be mediated by nNO. Mediation analyses further supported that reduced Pnvf in these regions underlies worse neurocognitive outcome in CHD patients and is associated with nitric oxide bioavailability. Impaired neuro-vascular function, which may be non-invasively estimated via combined arterial-spin label and BOLD MR imaging, is a nitric oxide bioavailability dependent factor implicated in adverse neurocognitive outcomes in pediatric and young adult CHD.

Abstract Background Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. Methods PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms. Results Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19–90.8) and specificity of 100.0% (95% CI 91.1–100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67–97.33) and specificity of 98.1% (95% CI 88.42–99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7–88.8) and specificity 75% (95% CI 67.0–81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0–85.0) and specificity 94.4% (95% CI 89.0–97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows’ interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59–0.73) for effusion and 0.31 (95% CI 0.24–0.38) for function among the fellows. Conclusion Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice.

Knowledge regarding bacterial dynamics during crop ensiling is important for understanding of the fermentation process and may facilitate the production of nutritious and stable silage. The objective of this study was to analyze the bacterial dynamics associated with whole crop wheat silage with and without inoculants. Whole crop wheat was ensiled in laboratory silos, with and without Lactobacillus inoculants (L. plantarum, L. buchneri), for 3 months. Untreated and L. plantarum-treated silages were sampled at several times during ensiling, while L. buchneri-treated silage was sampled only at 3 months. Bacterial composition was studied using next generation sequencing approach. Dominant bacteria, before ensiling, were Pantoea (34.7%), Weissella (28.4%) and Pseudomonas (10.4%), Exiguobacterium (7.8%), and Paenibacillus (3.4%). Exogenous inoculants significantly affected bacterial composition and dynamics during ensiling. At 3 months of ensiling, Lactobacillus dominated the silage bacterial population and reached an abundance of 59.5, 92.5, and 98.2% in untreated, L. plantarum- and L. buchneri-treated silages, respectively. The bacterial diversity of the mature silage was lower in both treated silages compared to untreated silage. Functional profiling of the bacterial communities associated with the wheat ensiling demonstrated that the abundant pathways of membrane transporters, carbohydrate and amino acids metabolisms followed different pattern of relative abundance in untreated and L. plantarum-treated silages. Only three pathways, namely base-excision repair, pyruvate metabolism and transcription machinery, were significantly different between untreated and L. buchneri-treated silages upon maturation. Lactic acid content was higher in L. plantarum-treated silage compared to untreated and L. buchneri-treated silage. Still, the pH of both treated silages was lower in the two Lactobacillus-treated silages compared to untreated silage. Aerobic stability test demonstrated that L. plantarum-, but not L. buchneri-supplement, facilitated silage deterioration. The lower aerobic stability of the L. plantarum-treated silage may be attributed to lower content of acetic acid and other volatile fatty acids which inhibit aerobic yeasts and molds. Indeed, high yeast count was recorded, following exposure to air, only in L. plantarum-treated silage, supporting this notion. Analysis of bacterial community of crop silage can be used for optimization of the ensiling process and the selection of appropriate inoculants for improving aerobic stability.

Simplification of antiretroviral therapy in patients with suppressed viremia may minimize long-term adverse effects. The study's primary objective was to determine whether abacavir/lamivudine + atazanavir (ABC/3TC+ATV) was virologically non-inferior to tenofovir/emtricitabine + atazanavir/ritonavir (TDF/FTC+ATV/r) over 24 weeks in a population of virologically suppressed, HIV-1 infected patients.This open-label, multicenter, non-inferiority study enrolled antiretroviral experienced, HIV-infected adults currently receiving a regimen of TDF/FTC+ATV/r for ≥ 6 months with no history of virologic failure and whose HIV-1 RNA had been ≤ 75 copies/mL on 2 consecutive measurements including screening. Patients were randomized 1 ∶ 2 to continue current treatment or simplify to ABC/3TC+ATV.The primary endpoint was the proportion of patients with HIV-RNA

Lucerne and two maize crops were ensiled with and without Lactobacillus plantarum and fermented for 4 or 60 d to assess the effect of inoculant on in vitro rumen fermentation of the resulting silages. Water and 80% ethanol extracts of the silages were also analysed for effects on in vitro rumen fermentation. The inoculant affected lucerne silage characteristics but had little effect on the maize silages. In vitro fermentation of the silages showed few effects except increased microbial biomass yield (MBY) at 24 h in the inoculant-treated lucerne silages. In vitro fermentation of the lucerne silage water extracts produced no differences due to treatment except for reduced MBY in the inoculant-treated extracts. The ethanol extracts produced results inconsistent with the in vitro results of the silages. Consequently it appears that the factor in in vitro fermentation of inoculated silages causing increased MBY was in neither the water nor ethanol extracts.

Little is known about experiences of physicians when deciding on initiating life support during medical crises of mass casualties and undersupply. We performed a qualitative analysis of interviews with 14 physicians about their decision-making experience when considering initiating mechanical ventilation in patients with severe COVID-19 during the early pandemic. Three themes were revealed: (a) The accumulating clinical experience with invasive ventilation, and the physicians' perception of ventilation as effective or futile in these patients; (b) Preferences of patients and their families regarding mechanical ventilation; and (c) Economic, logistic, and organizational considerations of the undersupplied healthcare system. The circumstances under which end-of-life decisions were made often caused moral injury to physicians, in particular when their personal ethical standpoints were not integrated in the decision-making process. Our findings explore the moral injury suffered by physicians and may help identify strategies to mitigate moral injury of healthcare staff in times of medical crisis.

Musical performance relies on nonverbal cues for conveying information among musicians. Human musicians use bodily gestures to communicate their interpretation and intentions to their collaborators, from mood and expression to anticipatory cues regarding structure and tempo. Robotic Musicians can use their physical bodies in a similar way when interacting with fellow musicians. The paper presents a new theoretical framework to classify musical gestures and a study evaluating the effect of robotic gestures on synchronization between human musicians and Shimon - a robotic marimba player developed at Georgia Tech. Shimon utilizes head and arm movements to signify musical information such as expected notes, tempo, and beat. The study, in which piano players were asked to play along with Shimon, assessed the effectiveness of these gestures on human-robot synchronization. Subjects were evaluated for their ability to synchronize with unknown tempo changes as communicated by Shimon's ancillary and social gestures. The results demonstrate the significant contribution of non-instrumental gestures to human-robot synchronization, highlighting the importance of non-music-making gestures for anticipation and coordination in human-robot musical collaboration. Subjects also indicated more positive feelings when interacting with the robot's ancillary and social gestures, indicating the role of these gestures in supporting engaging and enjoyable musical experiences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gao, Rogel, Sankaranarayanan, Dowling and Weinberg.)

Optical-resolution fluorescence imaging through and within complex samples presents a major challenge due to random light scattering, with substantial implications across multiple fields. While considerable advancements in coherent imaging through severe multiple scattering have been recently introduced by reflection matrix processing, approaches that tackle scattering in incoherent fluorescence imaging have been limited to sparse targets, require high-resolution control of the illumination or detection wavefronts, or require a very large number of measurements. Here, we present an approach that allows the adaptation of well-established reflection matrix techniques to scattering compensation in incoherent fluorescence imaging. We experimentally demonstrate that a small number of conventional wide-field fluorescence microscope images acquired under unknown random illuminations can effectively be used to construct a virtual fluorescence-based reflection matrix. Processing this matrix by an adapted matrix-based scattering compensation algorithm allows reconstructing megapixel-scale images from <150 acquired frames, without any spatial light modulators or computationally intensive processing.

Importance: Acute back pain is a common reason for primary care visits and often results in low-value spinal imaging., Objective: To evaluate the effect of a standardized patient-delivered intervention on rates of low-value spinal imaging among primary care patients with acute low back pain., Design, Setting, and Participants: In this randomized clinical trial, physicians or advanced practice clinicians were recruited from March 22 to August 5, 2021, from 10 adult primary care or urgent care clinics in Sacramento, California. The intervention period was from May 1, 2021, to March 30, 2022, with follow-up from October 28, 2021, to June 30, 2023. Analyses were performed from April 1 to June 25, 2024., Intervention: Clinicians were randomized 1:1 to intervention or control. Intervention clinicians received 3 simulated office visits, each with a standardized patient instructor (SPI) portraying a patient with acute uncomplicated back pain. At each visit, SPIs provided clinician feedback guided by a 3-step model: (1) set the stage for deferred imaging by building trust, (2) convey empathy, and (3) communicate optimism while advocating watchful waiting without imaging. Control clinicians received no intervention., Main Outcomes and Measures: The primary outcome was lumbar spinal imaging completion within 90 days of acute low back pain visits, with study clinicians assessed up to 18 months of follow-up. Secondary outcomes were cervical spine imaging completion after acute neck pain visits, any imaging completion after an adult visit, patient experience ratings of clinicians (scale range, 0-100), and use of targeted communication skills during an audio-recorded standardized patient evaluation visit at median follow-up of 16.8 months (range, 14.1-18.0 months)., Results: The analysis included 53 clinicians; mean (SD) age was 46.7 (1.0) years, and 35 (66.0%) reported female gender. A total of 25 were in the intervention group and 28 in the control group. After adjustment for prerandomization rates, patients with acute low back pain who saw intervention and control clinicians during follow-up had similar rates of lumbar imaging (194 of 1234 clinic visits [15.7%] vs 226 of 1306 clinic visits [17.3%]; adjusted ratio of postintervention vs preintervention odds ratios [AORR], 1.00; 95% CI, 0.72-1.40). Adjusted follow-up rates of imaging for acute neck pain (AORR, 1.16; 95% CI, 0.83-1.63) and overall imaging (AORR, 1.07; 95% CI, 0.97-1.19) were not significantly different among patients of intervention and control clinicians. Intervention and control clinicians had similar mean (SD) patient experience ratings during follow-up (88.6 [28.7] vs 88.8 [28.3]; adjusted mean difference-in-differences, -1.0; 95% CI, -3.0 to 0.9). During audio-recorded standardized patient visits, intervention clinicians had significantly better ratings than controls on eliciting the patient's perspective (adjusted standardized difference [ASD], 0.62; 95% CI, 0.05-1.19) and conveying empathy (ASD, 1.16; 95% CI, 0.55-1.77)., Conclusions and Relevance: In this randomized clinical trial of an educational intervention using simulated office visits to encourage a watchful waiting approach for acute low back pain, the intervention had no significant effect on low-value spinal imaging rates or patient experience ratings., Trial Registration: ClinicalTrials.gov Identifier: NCT04255199.

A coherent perfect absorber exploits the interferometric nature of light to deposit all of a light field's incident energy into an otherwise weakly absorbing sample. The downside of this concept is that the necessary destructive interference in coherent perfect absorbers gets easily destroyed both by spectrally or spatially detuning the incoming light field. Each of these two limitations has recently been overcome by insights from exceptional-point physics and by using a degenerate cavity, respectively. Here, we show how these two concepts can be combined into a new type of cavity design, which allows broadband exceptional-point absorption of arbitrary wavefronts. We present two possible implementations of such a massively degenerate exceptional-point absorber and compare analytical results with numerical simulations.

Conventional fiber-bundle-based endoscopes allow minimally invasive imaging through flexible multi-core fiber (MCF) bundles by placing a miniature lens at the distal tip and using each core as an imaging pixel. In recent years, lensless imaging through MCFs was made possible by correcting the core-to-core phase distortions pre-measured in a calibration procedure. However, temporally varying wavefront distortions, for instance, due to dynamic fiber bending, pose a challenge for such approaches. Here, we demonstrate a coherent lensless imaging technique based on intensity-only measurements insensitive to core-to-core phase distortions. We leverage a ptychographic reconstruction algorithm to retrieve the phase and amplitude profiles of reflective objects placed at a distance from the fiber tip, using as input a set of diffracted intensity patterns reflected from the object when the illumination is scanned over the MCF cores. Our approach thus utilizes an acquisition process equivalent to confocal microendoscopy, only replacing the single detector with a camera.

We describe the case of a 28-year-old man with Brugada syndrome who received single-shot adductor canal and sciatic nerve blocks for the management of post-operative pain related to extensive orthopedic injuries. Low-dose ropivacaine with glucocorticoid additives was administered without any EKG changes, arrhythmias, or syncopal sensations. The patient experienced pain relief for over 24 h and was monitored on telemetry with defibrillator pads as a cardiac precaution. This case adds a valuable data point in the limited canon of information on the safety and efficacy of regional anesthesia in Brugada syndrome for the perioperative physician., (© 2024 Greater Baltimore Medical Center.)

The unique perspective of children communicating about the loss of a parent has rarely been studied. In this qualitative research, we interviewed 12 children aged 7-12 and asked them about their experience communicating their loss. The children's verbal and non-verbal communication was characterized by constant movements away from and closer to various aspects of their loss, illustrated by three main themes: (a) children either talking about the loss or not talking about it; (b) first talking about the loss and then stopping to talk about it; and (c) simultaneously talking and not talking about the loss. Based on Stern's interpersonal relational thinking, our findings indicate that children wish to talk about the loss but also to avoid talking about it. The possibility of choosing to talk and not to talk with themselves and close individuals about the loss allows children to think about and articulate their feelings and thoughts.

Fiber-based confocal endomicroscopy has shown great promise for minimally-invasive deep-tissue imaging. Despite its advantages, confocal fiber-bundle endoscopy inherently suffers from undersampling due to the spacing between fiber cores, and low collection efficiency when the target is not in proximity to the distal fiber facet. Here, we demonstrate an adaptation of image-scanning microscopy (ISM) to lensless fiber bundle endoscopy, doubling the spatial sampling frequency and significantly improving collection efficiency. Our approach only requires replacing the confocal detector with a camera. It improves the spatial resolution for targets placed at a distance from the fiber tip, and addresses the fundamental challenge of aliasing/pixelization artifacts.

Competing Interests: Competing interests: GW is an officer and shareholder of ResQ Pharma, Inc.

A newborn with congenital segmental dilatation of the intestine affecting the colon is presented. This rare condition, unrelated to Hirschsprung's disease, may affect any portion of the bowel and is characterized by focal dilatation of a segment of bowel flanked by normal proximal and distal bowel. While reported in the surgical literature, congenital segmental dilatation of the intestine has not been reported in the pediatric radiology literature even though pediatric radiologists may be the first to encounter imaging suggesting the diagnosis. We therefore present the characteristic imaging findings, including abdominal radiographs and images from a contrast enema, and discuss the clinical presentation, pathology findings, associations, treatment, and prognosis of congenital segmental dilatation of the intestine to increase awareness of this unusual diagnosis., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Infusion of lipid emulsion for drug overdose arose as a treatment for local anaesthetic systemic toxicity (LAST) initially based on laboratory results in animal models with the subsequent support of favourable case reports. Following successful translation to the clinic, practitioners also incorporated lipid emulsion as a treatment for non-local anaesthetic toxicities but without formal clinical trials. Recent clinical trials demonstrate a benefit of lipid emulsion in antipsychotic, pesticide, metoprolol and tramadol overdoses. Formal trials of lipid emulsion in LAST may never occur, but alternative analytic tools indicate strong support for its efficacy in this indication; for example, lipid emulsion has obviated the need for cardiopulmonary bypass in most cases of LAST. Herein, we describe the pre-clinical support for lipid emulsion, evaluate the most recent clinical studies of lipid emulsion for toxicity, identify a possible dose-based requirement for efficacy and discuss the limitations to uncontrolled studies in the field., (© 2022 British Pharmacological Society.)

Bio-derived materials are becoming increasingly sought-after as a sustainable alternative to petrochemical-derived polymers. In the present pilot-scale study, a hemicellulose-rich compression screw pressate, obtained from the pre-heating stage of thermo-mechanical pulping (TMP) of radiata pine, was purified by treatment with adsorbent resin (XAD7), then ultrafiltered and diafiltered at 10 kDa to isolate the high-molecular weight (MW) hemicellulose fraction (yield 18.4% on pressate solids), and, finally, reacted with butyl glycidyl ether to plasticise the hemicelluloses. The resulting light brown hemicellulose ethers (yield 102% on the isolated hemicelluloses) contained ca. 0.5 butoxy-hydroxypropyl side chains per pyranose unit and had weight- and number-average MWs of 13,000 Da and 7200 Da, respectively. The hemicellulose ethers may serve as raw material for bio-based products such as barrier films.

Gender is a multidimensional construct that differentiates males and females according to its meanings in different socio-cultural contexts. Recovery capital (RC) describes the internal and external resources individuals employ and/or have access to when overcoming addictions. Negative RC refers to elements that hinder recovery. The literature on gender and RC is baffling since unlike quantitative studies that have found no differences between men and women in the levels of RC, qualitative comparisons indeed underscore differences. This study employed qualitative and quantitative research methods to explore how men and women with gambling disorder (GD) understand and employ gender as a factor in their recovery. Participants with GD (N = 133, 39 women) answered an open-ended question on gender as a component in their recovery. Content analysis revealed that 41.35% of the interviewees did not consider gender as a significant factor in recovery. By contrast, 58.65% viewed gender as important to recovery, indicating four gender-related elements that either enhance and/or hinder recovery: gender stereotypes, gender roles, mixed-gender therapeutic space, and sex in exchange for money for gambling. Chi-square analyses showed no differences between men and women in the distribution of the relevance of gender to recovery. Both groups reported similar perceptions of gender in relation to recovery, and identified similar gender-related specific elements that enhanced or hindered recovery from GD except for exchanging sex for money for gambling. These findings are explained by a combination of macro and micro-level theories that result in a new conceptualization of RC. We coined the term "Recovery Capital in Action" to show how the "RC toolkit" that individuals employ can hinder or enhance their recovery depending on cultural context, and that gender can be both a negative and a positive RC. Mental health professionals should consider the interplay between gender and the socio-cultural contexts during recovery., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: Effective communication skills are essential for optimally managing chronic pain and opioids. This exploratory, sequential mixed methods study tested the effect of a novel framework designed to improve pain-related communication and outcomes., Methods: Study 1 developed a novel 5-step framework for helping primary care clinicians discuss chronic pain and opioids with patients. Study 2 pilot tested an intervention for teaching this framework using standardized patient instructors-actors trained to portray patients and provide immediate clinician feedback-deployed during regular clinic hours. Primary care physicians were randomized to receive either the intervention or pain management recommendations from the Centers for Disease Control and Prevention. Primary outcomes were pain-related interference at 2 months and clinician use of targeted communication skills (coded from transcripts of audio-recorded visits); secondary outcomes were pain intensity at 2 months, clinician self-efficacy for communicating about chronic pain, patient experience, and clinician-reported visit difficulty., Results: We enrolled 47 primary care physicians from 2 academic teaching clinics and recorded visits with 48 patients taking opioids for chronic pain who had an appointment scheduled with an enrolled physician. The intervention was not associated with significant changes in primary or secondary outcomes other than clinician self-efficacy, which was significantly greater in the intervention group., Discussion: This study developed a novel framework and intervention for teaching clinician pain-related communications skills. Although the intervention showed promise, more intensive or multicomponent interventions may be needed to have a significant impact on clinicians' pain-related communication and pain outcomes., Competing Interests: This project was funded by National Institutes of Health grant K23DA043052 and the University of California Davis Department of Internal Medicine. Funders had no input into study design, conduct, analysis, or manuscript preparation. Dr S.G.H. is supported by grants from the National institute on Drug Abuse (R01-DA044282) and the US Department of Justice (2018-PM-BX-K026). Dr C.I.C. is supported by grants and contracts from the National Institute on Drug Abuse (UG1-DA040314, R01-DA047405) and the Food and Drug Administration. She has received support managed through her institution from the Industry PMR Consortium, a consortium of companies working together to conduct post-marketing studies required by the Food and Drug Administration that assess risks related to opioid analgesic use. Dr M.L.D. is an author for UpToDate. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

One of the key insights of non-Hermitian photonics is that well-established concepts such as the laser can be operated in reverse to realize a coherent perfect absorber (CPA). Although conceptually appealing, such CPAs are limited so far to a single, judiciously shaped wavefront or mode. Here, we demonstrate how this limitation can be overcome by time-reversing a degenerate cavity laser based on a unique cavity that self-images any incident light field onto itself. Placing a weak, critically coupled absorber into this cavity, any incoming wavefront, even a complex and dynamically varying speckle pattern, is absorbed with close to perfect efficiency in a massively parallel interference process. These characteristics open up interesting new possibilities for applications in light harvesting, energy delivery, light control, and imaging.

Museum engagement may be an effective approach for decreasing social disconnection and pain among individuals living with chronic pain. In October 2019, we launched a randomized controlled trial to assess the feasibility of museum engagement for individuals living with chronic pain; the study was halted in March, 2020 due to Covid-19-related safety concerns. This paper describes the process of transitioning from in-person to virtual museum programing in order to continue the study. Virtual museum programing is a feasible option for individuals living with chronic pain that is amenable to research and which may improve accessibility, inclusivity, and scalability relative to in-person programing., Competing Interests: The authors have no conflicts of interest to declare., (© The Author(s) 2022.)

Bladder prolapse through a patent urachus is rare. We present a newborn with an unusual exophytic, erythematous umbilical mass. Voiding cystography readily demonstrated continuity of the bladder dome with the umbilical mass, confirming bladder prolapse through a patent urachus. The diagnosis of bladder prolapse was rapidly made in a second newborn with similar imaging and clinical findings and confirmed by cystography. We discuss the embryology of this condition including the association with a vesico-allantoic cyst in utero. Pre- and postnatal images are presented. The use of cystography in diagnosis is emphasized., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Chronic pain is a leading cause of morbidity and disability across the world. Cultural engagement may be a valuable tool in addressing the social disconnection that often accompanies chronic pain. This study sought to develop a framework for arts in health programs targeting individuals with chronic pain., Study Design: Sequential explanatory mixed-methods study., Methods: Web-based, cross-sectional survey sent to arts and cultural professionals to assess their experience with arts in health programming. Semi-structured interviews conducted with a sample of survey respondents to explore their perspectives on targeted arts in health programming for individuals with chronic pain., Results: Between October 2019 and January 2020, 208 surveys were completed by arts and cultural professionals. One hundred and twenty (58%) of the respondents indicated that they currently run an arts in health or museums in health program. Among these 120 respondents, 52 (43%) targeted older adults, 50 (42%) targeted individuals with mental health concerns, and 18 (15%) targeted individuals living with pain. Improving well-being (101 [84%]) and reducing social isolation (90 [75%]) were the most common intended program outcomes, while improving pain was the least common outcome (26 [22%]). Fifteen survey respondents were interviewed. Interviewees identified four interdependent themes regarding best practices for arts in health programs pertaining to (1) program content and structure, (2) program facilitation, (3) partnerships, and (4) programs for individuals with chronic pain., Conclusions: The cultural sector can support chronic pain prevention and treatment efforts through the development of specialized programs. This study provides a framework for developing arts in health programs that support individuals living with chronic pain., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Research in creative robotics continues to expand across all creative domains, including art, music and language. Creative robots are primarily designed to be task specific, with limited research into the implications of their design outside their core task. In the case of a musical robot, this includes when a human sees and interacts with the robot before and after the performance, as well as in between pieces. These non-musical interaction tasks such as the presence of a robot during musical equipment set up, play a key role in the human perception of the robot however have received only limited attention. In this paper, we describe a new audio system using emotional musical prosody, designed to match the creative process of a musical robot for use before, between and after musical performances. Our generation system relies on the creation of a custom dataset for musical prosody. This system is designed foremost to operate in real time and allow rapid generation and dialogue exchange between human and robot. For this reason, the system combines symbolic deep learning through a Conditional Convolution Variational Auto-encoder, with an emotion-tagged audio sampler. We then compare this to a SOTA text-to-speech system in our robotic platform, Shimon the marimba player.We conducted a between-groups study with 100 participants watching a musician interact for 30 s with Shimon. We were able to increase user ratings for the key creativity metrics; novelty and coherence, while maintaining ratings for expressivity across each implementation. Our results also indicated that by communicating in a form that relates to the robot's core functionality, we can raise likeability and perceived intelligence, while not altering animacy or anthropomorphism. These findings indicate the variation that can occur in the perception of a robot based on interactions surrounding a performance, such as initial meetings and spaces between pieces, in addition to the core creative algorithms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Savery, Zahray and Weinberg.)

Background: Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests., Methods: We will use key informant interviews of clinicians and focus groups with primary care patients to refine a theory-informed standardized patient-based intervention designed to teach clinicians how to advise watchful waiting when patients request low-value spinal imaging for low back pain. We will test the effectiveness of the intervention in a randomized clinical trial. We will recruit 8-10 primary care and urgent care clinics (~ 55 clinicians) in Sacramento, CA; clinicians will be randomized 1:1 to intervention and control groups. Over a 3- to 6-month period, clinicians in the intervention group will receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain; SPIs will instruct clinicians in a three-step model emphasizing establishing trust, empathic communication, and negotiation of a watchful waiting approach. Control physicians will receive no intervention. The primary outcome is the post-intervention rate of spinal imaging among actual patients with acute back pain seen by the clinicians adjusted for rate of imaging during a baseline period. Secondary outcomes are use of targeted communication techniques during a follow-up visit with an SP, clinician self-reported use of watchful waiting with actual low back pain patients, post-intervention rates of diagnostic imaging for other musculoskeletal pain syndromes (to test for generalization of intervention effects beyond back pain), and patient trust and satisfaction with physicians., Discussion: This trial will determine whether standardized patient instructors can help clinicians develop skill in negotiating a watchful waiting approach with patients with acute low back pain, thereby reducing rates of low-value spinal imaging. The trial will also examine the possibility that intervention effects generalize to other diagnostic tests., Trial Registration: ClinicalTrials.gov NCT04255199 . Registered on January 20, 2020.

Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non-anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at-risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care., (© 2021 Association of Anaesthetists.)

Background: Epinephrine is recommended in contemporary educational efforts by the American Heart Association (AHA) as central to adult Advanced Cardiac Life Support (ACLS). However, the International Liaison Committee on Resuscitation (ILCOR) 2019 recommendations update describes large evidentiary gaps for epinephrine use in cardiopulmonary resuscitation, highlighting that clinical and experimental evidence do not support the current AHA recommendations., Objective: This controversies article was written as a response to updated AHA and ILCOR adult ACLS recommendations in late 2019. This report summarizes and evaluates the evidence surrounding epinephrine for cardiac arrest with a focus on the historical perspective of epinephrine research., Discussion: According to the 2019 AHA ACLS guidelines, epinephrine is an integral component of adult out-of-hospital cardiac arrest resuscitation. Epinephrine improves rates of return of spontaneous circulation and might provide benefit at different doses or in select resuscitation scenarios, such asystole as an initial rhythm at onset of resuscitation efforts. However, evidence indicates potential harms with routine use of standard dose epinephrine (1 mg/10 mL), with no improvement in neurologic or long-term outcomes., Conclusions: Despite years of use and inclusion in resuscitation guidelines, epinephrine is not associated with improved neurologic outcomes. The AHA Emergency Cardiovascular Care committee should revise ACLS guidelines reflecting evidence that standard-dose epinephrine offers little benefit to successful patient recovery including neurologic outcomes. Future resuscitation guidelines should reflect this important consideration., Competing Interests: Declaration of Competing Interest Dr. Weinberg is an officer and shareholder of ResQ Pharma, Inc. Authors have no other conflicts of interest., (Published by Elsevier Inc.)

Competing Interests: Competing interests: This study is independent of the American Society of Regional Anesthesia and Pain Medicine (ASRA). MFM, JMN, and GW served on the 2010 and 2017 ASRA LAST practice advisory panels. GW is an officer and shareholder of ResQ Pharma.

We demonstrate an approach that allows taking videos at very high frame-rates of over 100,000 frames per second by exploiting the fast sampling rate of the standard rolling-shutter readout mechanism, common to most conventional sensors, and a compressive-sampling acquisition scheme. Our approach is directly applied to a conventional imaging system by the simple addition of a diffuser to the pupil plane that randomly encodes the entire field-of-view to each camera row, while maintaining diffraction-limited resolution. A short video is reconstructed from a single camera frame via a compressed-sensing reconstruction algorithm, exploiting the inherent sparsity of the imaged scene.

Sonomyography (ultrasound imaging) offers a way of classifying complex muscle activity and configuration, with higher SNR and lower hardware requirements than sEMG, using various supervised learning algorithms. The physiological image obtained from an ultrasound probe can be used to train a classification algorithm which can run on real time ultrasound images. The predicted values can then be mapped onto assistive or teleoperated robots. This paper describes the classification of ultrasound information and its subsequent mapping onto a soft robotic gripper as a step toward direct synergy control. Support Vector Classification algorithm has been used to classify ultrasound information into a set of defined states: open, closed, pinch and hook grasps. Once the model was trained with the ultrasound image data, real time input from the forearm was used to predict these states. The final predicted state output then set joint stiffnesses in the soft actuators, changing their interactions or synergies, to obtain the corresponding soft robotic gripper states. Data collection was carried out on five different test subjects for eight trials each. An average accuracy percentage of 93% was obtained averaged over all data. This real-time ultrasound-based control of a soft robotic gripper constitutes a promising step toward intuitive and robust biosignal-based control methods for robots.

Bereaved parents who have undergone feticide are reluctant to participate in a joint interview. Barthes' intertextuality approach is used to examine the texts of their separate interviews in order to arrive at an interpretive understanding of this phenomenon. Our results indicate that socially constructed gender roles and medical-biological and economic constructs, shape the parents' perceptions and actions. Both men and women behave based on the similarities with their partner and perceive any differences as a threat. The proposal to take part in a joint interview was perceived as a danger to the agreed-upon socially constructed views. Implications are presented.

Objectives: To assess and compare dietpractices, body mass index (BMI), and oral health-related quality of life (OHRQoL) in adults with and without periodontitis., Methods: Demographics, health-related behaviors, BMI, dental and periodontal parameters, diet practices, and Oral Health Impact Profile-14 (OHIP-14) were collected from 62periodontitis patients and 100 controls without periodontitis., Results: Havingperiodontitis was positively associated with male sex ( p =0.004), older age ( p <0.001), smoking pack-years ( p = 0.006), weight ( p = 0.008), BMI ( p = 0.003), number of meals per day ( p <0.001) and had a negative associationwithdecayed teeth ( p = 0.013), alcohol ( p = 0.006), and sweets ( p = 0.007) consumption.Periodontitis patients were more likely to avoid carbonated beverages ( p = 0.028), hot ( p = 0.003), and cold drinks ( p = 0.013), cold ( p = 0.028), hardtextured ( p = 0.002), and fibrous foods ( p = 0.02) thanthe controls, and exhibited higher global OHIP-14 ( p <0.001) andmost domain scores. Age ( p <0.001), BMI ( p =0.045), number of meals per day ( p = 0.024), and global OHIP-14 score ( p <0.001) remained positivelyassociated with periodontitis in the multivariate analysis., Conclusions: Periodontitis patients exhibitedhigher BMI and altered dietpracticesand OHRQoL as compared to controls. Assessment of diet practices, BMI,and OHRQoLshould bepart of periodontal work-up. Dentists and dietitians shouldcollaborate to design strategies to addressthese challenges., Competing Interests: The authors declare no conflict of interest.